Ask The Green Nurse – The Compassionate Role of Cannabinoids in Palliative, Hospice, and End-of-Life Care

As a palliative care and cannabis nurse health coach and former hospice nurse, I have had the profound honor of guiding patients and their families through some of life’s most sacred and vulnerable moments. Throughout this journey, I’ve witnessed the remarkable power of plant medicines—not only in easing physical discomfort but also in bringing much needed peace to the patient and family, preserving dignity, and even sparking moments of joy during life’s final chapter. I have witnessed the profound connection that sacred plant medicine fosters between patients and their caregiving family members during end-of-life care.

In 2017, I worked with my first hospice patient who sought relief through medical cannabis in addition to his conventional care. He was a middle-aged man battling Stage IV lung cancer, and we met after I gave a presentation on the use of cannabinoids in end-of-life care at a hospice facility. His pain was excruciating and relentless, leaving him overwhelmed and struggling to find comfort, even as he felt ready to let go. Despite taking over 100mg of morphine daily in divided doses, the pain persisted with little relief. His condition was critical—he relied on a tracheostomy for breathing, a feeding tube for nutrition, and he was severely cachectic, unable to eat. Desperation for a better solution led him to explore cannabis as an alternative path to ease his suffering.

A compassionate community of caregivers came together to donate a high-dose THC Full Extract Cannabis Oil (FECO) for him, and I was honored to guide him and his care team on its proper use. Joining him, his hospice nurse, and his social worker, I spent over 90 minutes providing detailed education on cannabis oil—its properties, benefits, and application. As he took his first rice-grain-sized dose of the high-THC FECO oil, we sat together, waiting to observe its effects with care and attentiveness.

When the treatment finally took effect, the change we witnessed was remarkable. He looked at me, tears welling in his eyes, and smiled—a moment of pure relief after enduring so much pain. Almost immediately, he made his way to the fridge, grabbed an Ensure, and fed himself through his G-tube. The oil’s impact was both swift and profound.

I guided him on how to properly dose the high dose THC FECO oil twice daily, spacing it with his medications. Over the next two weeks, his quality of life improved significantly for someone in the final stages of life. He was able to welcome friends into his home to say their goodbyes and, most importantly, experienced a peaceful passing with effective pain management. His sister later shared her heartfelt gratitude, expressing how much it meant to her that his final days were defined by dignity and a noticeable absence of suffering. This experience emphasized the transformative potential of cannabinoids in end-of-life care while underscoring the critical need for compassionate and personalized support for patients during their final stages of life.

This blog delves into how cannabinoids can serve as a vital tool for fostering more compassionate and empowering end-of-life experiences. Beyond alleviating the physical symptoms, these compounds provide emotional and spiritual support, easing the profound challenges of the dying process with greater comfort and dignity. Drawing from my years of experience as a hospice nurse, I strongly advocate for the accessibility of cannabinoids and other plant-based entheogens for patients during the palliative care journey. These therapies offer not only critical physical relief, but they also provide the mental, emotional, and spiritual care necessary for truly holistic end-of-life support.

Supporting a loved one through the end-of-life journey is an act of profound compassion and love. Whether you are a family member, friend, nurse, or caregiver, helping them explore cannabinoids or other plant-based medicines to find comfort during this vulnerable time creates a sanctuary of care and support. In doing so, you provide not just physical relief but also emotional healing, standing beside them as a source of peace and strength. You become their medicine too, every bit as critical as every other tool.

The Compassionate Role of Cannabinoids for End-of-Life Care

As palliative and hospice care evolves towards more patient-centered and integrative approaches, cannabinoids are emerging as a compassionate and effective therapeutic option. For individuals coping with cancer-related symptoms, neurodegenerative diseases, or advanced chronic illnesses, cannabis offers a multidimensional solution that aligns with the core principles of comfort, dignity, and improved quality of life during end-of-life care. Compounds like THC, CBD, and their acidic precursors, THCA and CBDA, have demonstrated remarkable potential in relieving symptoms, providing emotional and spiritual solace, and enhancing overall well-being for those facing serious or terminal conditions.

I recently worked with a client who was caring for her father during his final stages of life as he battled metastatic cancer.We took a thoughtful and holistic approach, combining prescribed medications with carefully measured microdoses of a 1:1 THCA and CBD oil. The oil was administered both as a sublingual tincture directly, and then drops of that tincture were added to his favorite lotion to make a soothing topical lotion for him. To further enhance his comfort, she introduced a small portion of a gummy infused with THC, CBD, CBG, and CBN. She would gently place it inside his cheek, allowing it to dissolve and absorb through the oral mucosa, bypassing the need to chew or swallow. This compassionate method provided him with much-needed relief and support in his final days.

In this poignant and spirit-laden poem, a daughter becomes both healer and witness, tenderly guiding her father through his final journey on earth. Drawing on the sacred wisdom of plant medicine, she weaves love, memory, and surrender into a quiet, reverent ceremony of release. The piece pays tribute to the profound bond between parent and child, as well as the timeless, natural allies that bring peace in moments of farewell. In the end, she was his greatest medicine.

In this transformative landscape, the role of the Cannabis Nurse has become indispensable. As educators, advocates, and guides, we bridge the gap between plant-based medicine and compassionate clinical care, ensuring patients receive both informed and empathetic support on their journey. Too few are doing this.

Cannabinoids: A Natural Ally in Symptom Relief

Effective management of symptoms like pain, nausea, anxiety, and insomnia is a key focus of palliative care. Cannabinoids have emerged as a promising option for addressing these challenges. A 2018 meta-analysis by Mücke et al. highlights their ability to alleviate pain, boost appetite, and improve emotional well-being. Unlike opioids, which can lead to side effects such as sedation, confusion, constipation, and respiratory depression, cannabis provides relief with fewer adverse effects. This allows patients to maintain their clarity, dignity, and autonomy while managing their symptoms more comfortably.

A key objective in palliative care is to alleviate suffering while preserving a patient’s quality of life.

Cannabinoids, particularly delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), have shown significant effectiveness in alleviating pain, nausea, anxiety, and insomnia among terminally ill patients (Mücke et al., 2018). Unlike traditional opioids, cannabinoids offer powerful pain relief with a reduced risk of respiratory depression or cognitive side effects, enabling patients to stay alert and actively involved in their care. Evidence from research underscores these benefits: a meta-analysis of randomized controlled trials revealed that cannabinoids significantly enhance pain management, stimulate appetite, and improve emotional well-being (Mücke et al., 2018). These qualities make cannabinoids particularly valuable for individuals undergoing chemotherapy, managing AIDS-related wasting, or facing advanced neurological disorders.

Cannabis Nurses play a vital role in integrating cannabis into palliative care, offering specialized expertise to enhance patient outcomes. Trained to assess individual needs, evaluate the benefits and risks of cannabis use, and create personalized care plans, we ensure safe and effective application of cannabis therapies. Guided by the ANA approved Scope and Standards of Practice for Cannabis Nursing, we bring advanced knowledge in pharmacology, education on the endocannabinoid system, and a commitment to ethical care. With our unique skill set, we strive to improve patients’ quality of life through thoughtful, evidence-based cannabis care. And, we help them save time and money as they approach this novel field of complementary care.

Restoring Control and Enhancing Autonomy

Loss of control is a common and profound source of suffering in end-of-life experiences. By addressing the multifaceted nature of suffering—physical, psychological, and existential—cannabis offers patients a renewed sense of empowerment in their care. Unlike conventional pharmaceuticals, cannabis provides alternative options that help restore a feeling of agency. In hospice settings, patients using medical cannabis have reported significant improvements in pain relief, mood, appetite, and sleep. These benefits contribute to a more dignified, self-directed, and compassionate dying process (Barakji et al., 2023). Isn’t that what all of us would prefer?

Recent surveys reveal a growing willingness among hospice professionals to recommend cannabis, particularly in regions where its use is legally supported by state legal programs (Costantino et al., 2019). This shift highlights an evolving dedication to respecting patient autonomy and providing culturally sensitive care as regulatory frameworks continue to advance.

Cannabis Nurses uphold patient autonomy through a shared decision-making approach. They provide education on product options such as tinctures, edibles, and vaporizers, guide dosing strategies, and address potential interactions. As we present options, the patient and family are the ones to actually select the path. By doing so, we empower patients and their families to make well-informed decisions that align with their core values and personal needs.

Cannabis as a Spiritual and Emotional Companion

Dying is not just a physical process—it is profoundly emotional and spiritual. Beyond addressing physical symptoms, cannabinoids may offer support for the psycho-spiritual dimensions of the end-of-life journey. Patients have reported that cannabis can enhance introspection, foster a deeper sense of connection, and alleviate existential distress, particularly when integrated into palliative care (Miller, 2022). This is especially meaningful in faith-based or spiritual hospice settings, where sacred plant medicine can complement contemplative practices. By addressing the mind, body, and spirit, this approach aligns seamlessly with the nursing standards of holistic care.

The use of cannabis in hospice care, including its role in spiritual discussions, highlights a growing societal acceptance of medical cannabis. A 2022 survey by MorseLife Health System revealed an intriguing connection between patients’ religious beliefs and their openness to cannabis, pointing to an evolving integration of plant medicine into ethical and spiritual practices. In hospice settings, Cannabis Nurses play a vital role in facilitating the thoughtful and sacred use of cannabis. They support patients through legacy work, grief management, and life reviews, while also identifying signs of spiritual distress. By collaborating with chaplains, therapists, and families, Cannabis Nurses help create meaningful, personalized rituals involving cannabis, enhancing holistic end-of-life care when appropriate.

Provider Perspectives and Practical Considerations

Clinicians in palliative care are increasingly recognizing cannabis as a valuable tool, particularly for patients who have exhausted traditional treatments or prefer more natural alternatives (Hardy & Herbert, 2021). While challenges persist—such as inconsistent dosing, legal restrictions, and gaps in provider education—growing patient demand continues to drive innovation and exploration in this new field.

One notable benefit of cannabis is its potential to reduce polypharmacy by replacing or complementing medications for pain, anxiety, and sleep. This holistic reduction in pharmaceutical use can help minimize side effects and drug interactions, making it especially advantageous for frail or elderly patients (da Costa & de Carvalho, 2022).

Cannabis Nursing Provides Clinical Expertise and Ethical Advocacy

Cannabis Nurses work at the crossroads, blending art and science with compassion. As skilled clinicians, they navigate the complexities of polypharmacy, drug interactions, and disease-specific care. As passionate advocates, they champion equitable access, cultural sensitivity, and patient safety within an ever-changing regulatory landscape.

A 2019 survey of hospice professionals highlighted significant interest in integrating cannabis into care. However, many cited legal uncertainty and inadequate education as major barriers (Costantino et al., 2019). Cannabis Nurses bridge this gap by staying informed on evolving policies, educating interdisciplinary teams, and helping to destigmatize cannabis use, particularly among vulnerable populations.

Moving Forward: A Call for Integrative Care Models

To truly embrace a whole-person approach to care, providers must stay informed, curious, and adaptable to the expanding research and growing cultural acceptance of cannabinoids. This requires a commitment to ongoing education and a willingness to explore emerging evidence that underscores their therapeutic potential. By incorporating cannabis into palliative care programs, providers can empower patients to manage symptoms more effectively, easing suffering and fostering moments of connection, peace, and meaning during their final days.

Cannabinoids offer a distinctive opportunity to address complex symptoms such as chronic pain, nausea, anxiety, and insomnia in a way that is often gentler and more holistic than traditional treatments. By integrating cannabis into end-of-life care, providers can deliver not only symptom relief but also a sense of dignity, allowing patients to feel greater control over their final journey.

Integrating Cannabis Nursing into Palliative Care

The integration of cannabis into hospice and palliative care is no longer a concept on the horizon—it has become an ethical imperative. With growing public interest and expanding clinical evidence, Cannabis Nurses are leading the way, delivering safe, effective, and personalized care. These professionals embody multiple roles: educators, caregivers, advocates, and healers, merging the art of traditional nursing with the transformative potential of plant-based therapies. From alleviating intractable pain and promoting restful sleep to facilitating intimate legacy conversations through mindful cannabis rituals, Cannabis Nurses are redefining end-of-life care. Their work not only enhances patient outcomes but also reclaims the sacredness of the dying process, offering comfort and dignity in life’s final chapter.

Incorporating cannabinoids into palliative care transcends mere symptom management. It is about restoring humanity, nurturing compassion, and honoring the unique complexities of each individual’s journey. By harmonizing cutting-edge scientific advancements with the profound act of caregiving, we elevate both the practice and experience of end-of-life care, ensuring it is as meaningful as it is compassionate. Cannabis nurses are revolutionizing healthcare by pioneering advancements in palliative and hospice care, improving the quality of life for patients and their families.

Earlier this year, we hosted a webinar for Empowered Endings on the use of cannabinoids in end-of-life care, specifically in palliative and hospice settings. The presentation included detailed slides and case studies, offering valuable insights into how cannabinoids can be utilized to enhance comfort and care during this critical stage of life. The webinar is available for viewing here on The Green Nurse YouTube Channel – The Green Nurse Webinar on Cannabinoids for End of Life Care

With you on the journey,

Ask The Green Nurse with Sherri Mack BSN, RN & Elisabeth Mack MBA, BSN, RN

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References

Barakji, B., Gentzler, A., & Gabbard, J. (2023). Medicinal cannabis – has it found a place in palliative care? Palliative Care & Social Practice, 17.
Costantino, R. C., Felten, N., Todd, M., Maxwell, T., & McPherson, M. L. (2019). A survey of hospice professionals regarding medical cannabis practices. Journal of Palliative Medicine, 22(10), 1208–1212.
da Costa, V., & de Carvalho, W. (2022). Use of medicinal cannabis for palliative care patients: A systematic review. Journal of Biosciences and Medicines, 10(9), 242–252.
Hardy, J., & Herbert, A. (2021). Medicinal cannabis use in palliative care. Australian Journal of General Practice, 50(6), 345–348.
Holistic Caring & The Green Nurse. Holistic Caring.
Miller, B. J. (2022). An honest look at marijuana and its place in palliative care. Center to Advance Palliative Care.
MorseLife Hospice and Palliative Care. (2022). Survey: Marijuana, religion, & end-of-life care in hospice. MorseLife Health System.
Mücke, M., Weier, M., Carter, C., Copeland, J., Degenhardt, L., Cuhls, H., Radbruch, L., Häuser, W., & Conrad, R. (2018). Systematic review and meta‐analysis of cannabinoids in palliative medicine. Journal of Cachexia, Sarcopenia and Muscle, 9(2), 220–234.